Relationship Between Blood Pressure After Early Endovascular Treatment And Clinical Prognosis In Patients With Acute Large Vessel Occlusion Stroke

Objective:To evaluate the effects of blood pressure（BP）profiles within 24 hours,including mean blood pressure（MBP）and blood pressure variability（BPV）for the 90-day clinical prognosis after early endovascular treatment（EVT）for acute large vessel occlusion stroke（ALVOS）of anterior circulation.Methods:The patients with ALVOS who underwent EVT were collected in Yijishan Hospital of Wannan Medical College from July 2014 to February 2019.The 90-days modified Rankin Scale score≤2 was defined as favorable outcome,and the modified Thrombolysis in Cerebral Infarction（mTICI）>2a was regarded as successful recanalization.The univariate and multivariate logistic regression analysis were used to investigate whether postoperative blood pressure is an independent risk factor affecting patient prognosis and whether it is related to recanalization status.Results:Two hundred and sixteen patients were collected[Male 115（53.2%）,mean age68 years,median baseline ASPECT score was 9,median baseline NIHSS score was 16,mean onset to puncture time was 259.14 minutes],95（44%）patients were favorable outcome and 121（56%）patients were poor outcome.Patients with favorable outcome had lower SBP_mean（121 mmHg vs 125 mmHg,P=0.012）and SBP_max（147 mmHg vs154mmHg,P=0.007）.Yet,regardless of systolic or diastolic blood pressure,BPV parameters such as SD,CV,and SV were significantly lower than those in the poor outcome group（10.79 vs 12.51,P=0.002;8.89 vs 10.00,P=0.010;11.80 vs 13.43,P=0.005）.On multivariable logistic regression analysis,both the SBP_SD（OR=1.116,95%CI:1.002-1.243;P=0.047）and SBP_SV（OR=1.116,95%CI:1.016-1.227;P=0.022）were independent risk factors of the 90-day clinical prognosis after EVT.Subgroup analysis was performed according to the recanalization status.Multivariable logistic regression analysis showed the SBP_SD（OR:1.164,95%CI:1.021-1.326;P=0.023）,the SBP_cv（OR:1.191,95%CI:1.007-1.409;P=0.041）and the SBP_SV（OR:1.141,95%CI:1.018-1.279;P=0.024）were independent risk factors of the 90-day clinical prognosis in patients with EVT.However,no significant association was found between BPV parameters and clinical prognosis in patients with unrecanalization.Conclusion:The postoperative BPV within 24 hours is an independent risk factor on favorable outcome in patients with ALVOS.Moreover,the correlation between 24-hour postoperative BPV and 90-day clinical prognosis depends to some extent on recanalization status.